1982969135 NPI number — MICHAEL N LIVINGSTON

Table of content: MICHAEL N LIVINGSTON (NPI 1982969135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982969135 NPI number — MICHAEL N LIVINGSTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIVINGSTON
Provider First Name:
MICHAEL
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982969135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 118008
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29423-8008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-302-8845
Provider Business Mailing Address Fax Number:
843-569-5872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9263 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
STE. D
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-7109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-302-8845
Provider Business Practice Location Address Fax Number:
843-569-5872
Provider Enumeration Date:
07/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  6779 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)